Health Research & Educational Trust

1 Health Research & Educational Trust Health Research & Educational Trust Transforming health care through research and education Making an Impact in 2010

Making an Impact in 2010 2 Health Research & Educational Trust Making an Impact in 2010 Today, more than 65 years after the American Hospital Association commissioned our first study, the Health Research & Educational Trust is taking a leading role in helping hospitals navigate the changing health care environment. As the research and educational affiliate of the AHA, HRET actively synthesizes and translates research into actionable knowledge, strategies, and tools that improve the delivery of health care by hospitals and providers in the communities they serve. Working with national partners, state hospital associations, and funders, HRET engages hospitals and other health care organizations to focus on key questions in the following areas of our research agenda: Quality/Cost/Disparities: Management research to provide operational advice on improving quality, reducing costs, and eliminating disparities. Care Coordination: Management and policy research to identify, test, and evaluate best practices in care coordination. Leadership/Governance: Management research to support leadership and governance in improvement. Payment Reform: Policy research to develop, test, and evaluate new models of payment reform. Translational Research: To identify and execute strategies and methods that facilitate disseminating and implementing research findings, knowledge, tools, and best practices. Quantitative Research: To analyze secondary data associated with health care performance across multiple dimensions. In addition to leading more than 25 applied research projects, HRET also stewards the AHA s strategic platform on accelerating performance improvement, Hospitals in Pursuit of Excellence. HPOE develops evidence-based tools and guides, offers leadership development through fellowships and networks, and engages hospitals in national improvement projects. The HPOE website, www.hpoe.org, provides numerous case studies as well as links to other initiatives, toolkits, and organization websites all to disseminate proven practices, drive performance improvement in quality and efficiency, and support delivery system transformation at the local level. Through our AHA affiliation, HRET accesses valuable resources, data, and thought leadership, and serves the research and information needs of the hospital field. Through our work with state hospital associations and partners like the Commonwealth Fund, the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality, HRET advances ideas and practices beneficial to health care practitioners, institutions, consumers, and society at large. The current era of change in the health care field presents tremendous opportunities along with challenges. Our 35-plus HRET team will keep working to identify and research relevant issues in the field and provide the resources and tools needed by hospitals and health systems to improve the delivery of patient care. Thank you for the privilege of working with you to further our mission. Maulik Joshi, DrPH President, HRET Senior Vice President of Research, AHA Alfred G. Stubblefield Chair, HRET Board of Trustees President, Baptist Health Care, Pensacola, FL

3 Health Research & Educational Trust HRET Making an Impact in 2010 Some of the ways we are making an impact in our mission to transform health care through research and education Central line-associated bloodstream infections reduced by 35 percent in more than 400 hospitals. Thirteen perinatal HIV prevention workshops conducted in 12 states since 2008. AHRQ patient safety tools implemented by more than 900 hospitals. More than 13,000 downloads of Hospitals in Pursuit of Excellence guides on readmissions, electronic health records, workforce practices to drive quality, and high performance. More than 9,000 downloads of Research Synthesis Reports on accountable care organizations, bundled payment, and the medical home. Results from the Employer Health Benefits Annual Survey cited by multiple sources nationally and viewed as the premier source for policymakers, researchers, and employers on understanding health benefit trends. More than 260 fellows have participated in the AHA-NPSF Patient Safety Leadership Fellowship, administered by HRET, since 2001. Four webinars in support of Hospitals in Pursuit of Excellence reached more than 300 hospitals. The Hospitals in Pursuit of Excellence website highlighted more than 200 case studies and 250 links to other resources and tools. Online toolkits on collecting race, ethnicity, and primary language data, HIV testing in emergency departments, and HIV testing and screening cost and reimbursement viewed more than 22,000 times. Health Services Research journal reached more than 7,500 individual and institutional subscribers. Peer-reviewed articles by HRET researchers published in Health Affairs, Health Care Management Review, and other journals. One hundred percent of HRET s customers rated HRET an 8, 9, or 10 on satisfaction and likelihood to work with us again.

Making an Impact in 2010 4 Our Vital Partners HRET does not work alone but partners with many organizations and professionals to carry out our mission. It is vital to work with organizations that not only support our projects financially but also provide extraordinary thought leadership and insights. We also work with multiple partner organizations to design, implement, and disseminate applied research and performance improvement resources. We appreciate the organizations and individuals we have the opportunity to work with every day. 2010 Customers American Hospital Association (AHA) Agency for Healthcare Research and Quality (AHRQ) American Health Quality Association (AHQA) American Institutes for Research (AIR) American Society for Healthcare Risk Management (ASHRM) The Commonwealth Fund Institute for Safe Medication Practices (ISMP) John A. Hartford Foundation Kaiser Family Foundation National Association for Healthcare Quality (NAHQ) 2010 Partners State, regional, and metropolitan hospital associations Academic institutions National societies and associations American Hospital Association affiliates (AHA Solutions, American Organization of Nurse Executives, Center for Healthcare Governance, Health Forum, Institute for Diversity in Health Management, Personal Membership Groups) HRET in Partnership with AHA Supporting hospitals and health systems in applied research, education, and performance improvement. HRET supports the AHA and its members in many ways that provide new information, insights, and perspectives to address emerging health care issues. For example, HRET is the home of Hospitals in Pursuit of Excellence, the AHA s strategic platform to accelerate performance improvement in the nation s hospitals and health systems. HRET also provides staff support to the AHA Committee on Research and the AHA Long-Range Policy Committee. The AHA Committee on Research develops and monitors the AHA s research agenda and in 2010 produced the Strategic Issues Forecast 2015. The AHA Long-Range Policy Committee annually prepares an extensive analysis of a key issue facing U.S. hospitals and health systems. In 2010, HRET supported development of the committee s report, A Call to Action: Creating a Culture of Health, which focuses on how hospitals can promote health and wellness in their organizations and communities.

5 Health Research & Educational Trust Several of our programs and initiatives are highlighted here. For more detailed information, visit our website at www.hret.org. Hospitals in Pursuit of Excellence (HPOE) Helping drive performance improvement in health care. HPOE is the AHA s strategic platform to accelerate performance improvement in the nation s hospitals and health systems. IMPACT: The HPOE website includes more than 200 case studies and more than 250 links to resources and tools. The top five case studies have been downloaded more than 3,000 times. VISIT: www.hpoe.org With Hospitals in Pursuit of Excellence the tools and resources that the AHA team have already provided and will continue to provide are critical. ~ Teri Fontenot, President and CEO, Woman s Hospital, Baton Rouge (La.), and AHA Chair-Elect We have found HPOE to be an easily accessible and valuable shared resource that helps our hospitals accelerate their own quality initiatives. ~ Karen S. Nelson, RN, Senior Vice President, Clinical Affairs, Massachusetts Hospital Association

Making an Impact in 2010 6 On the CUSP: Stop BSI and Stop CAUTI Saving lives, preventing suffering, and reducing health care costs. The Comprehensive Unit-based Safety Program (CUSP) transforms care and patient safety at the unit level. The goal of this groundbreaking project is to reduce the rate of central lineassociated bloodstream infections (CLABSI) nationwide as well as catheter-associated urinary tract infections (CAUTI). Implementation of the CUSP model has been found to sustain reductions in health care-associated infections over time and provides a foundation for other types of technical safety improvements. More than 1,000 hospitals in 46 states and the District of Columbia and Puerto Rico are participating or will be participating by early 2011. HRET staff and partners the Johns Hopkins Quality & Safety Research Group and the Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality worked with 26 state hospital associations to facilitate planning their project kickoffs and support implementation. Supported by the Agency for Healthcare Research and Quality and in partnership with the Johns Hopkins Quality & Safety Research Group, the Keystone Center for Patient Safety & Quality of the Michigan Health & Hospital Association, and investigators from the University of Michigan (CAUTI project). The kinds of improvements that have been made through CUSP in a relatively short period of time are breathtaking. ~ Thomas Zenty, CEO, University Hospitals, Cleveland, and AHA Board Member IMPACT: Preliminary analysis of the first two cohorts of participating states shows a 35 percent reduction in CLABSI in adult ICUs. VISIT: www.onthecuspstophai.org

7 Health Research & Educational Trust Perinatal HIV Prevention Increasing HIV testing and preventing mother-to-child transmission. Working with U.S. partners, HRET is using a national approach tailored to local needs to increase the number of hospitals that are implementing and sustaining programs of perinatal HIV prevention. Many of these programs focus on using rapid screening tests in labor and delivery for women with undocumented HIV status. For this project, HRET: IMPACT: Since 2008, HRET has conducted 13 one-day perinatal HIV prevention workshops Conducts state-specific, oneday workshops with an average attendance of 60 people at for 12 states and the District of Columbia, Facilitates the work of each. national perinatal experts, VISIT: www.hret.org/hiv-cost focusing on research and data Has developed a new toolkit to assess HIV testing costs and reimbursement Supported by the Centers for Disease Control and Prevention. Implementation of AHRQ Patient Safety Tools Promoting tools that advance quality and safety of care. Through face-to-face trainings, topic-centered web conferences, and customized communications, HRET is working closely with state hospital associations and several national organizations to promote and support the successful implementation of tools and resources from AHRQ. These evidence-based resources are designed to strengthen the quality and safety of patient care in hospitals and other provider settings. They include widely used tools such as TeamSTEPPS, Quality Indicators (QIs), Hospital Survey on Patient Safety Culture (HSOPS), and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), as well as others like the Door to Doc toolkit to re-engineer patient flow in the ED. National organizations working on the project include the Medical Group Management Association, the National Association of Public Hospitals and Health Systems, the Society for Healthcare Consumer Advocacy, and the National Association for Healthcare Quality. IMPACT: More than 600 hospitals have participated in face-to-face trainings or web conferences on QIs, Door to Doc, and TeamSTEPPS. More than 350 individuals have received certification as TeamSTEPPS master trainers. More than 200,000 copies of consumer patient safety educational materials have reached hospitals in 44 states. VISIT: AHRQ Patient Safety Tools The HRET team has been instrumental in accelerating national improvement to help eliminate hospital-acquired infections. ~ Zeff Ross, Senior Vice President and Chief Executive Officer, Memorial Regional Hospital, Florida

Making an Impact in 2010 8 Employer Health Benefits Annual Survey Serving as a key resource for policymakers, employers, and health researchers. Read the 2010 Survey Report. Supported by the Kaiser Family Foundation. To provide current information about the nature of employer-sponsored health benefits, the Kaiser Family Foundation and HRET conduct an annual national survey. The 2010 survey, conducted from January through May 2010 and reflecting 2009 health benefit information, shows increases in the average single and family premium as well as in the amount that workers pay for coverage. The 2010 survey is the eleventh survey that HRET and Kaiser have conducted together and has received extensive national media coverage. IMPACT: Each year, survey results are cited by policymakers and major news networks in the United States. Promoting Safety and Quality through Human Resource Practices Linking workforce practices to quality of care. Supported by the Agency for Healthcare Research and Quality. HRET examined human resource practices for enhancing safety and quality in health care and developed case studies of successful strategies and practices at five hospitals. Using Workforce Practices to Drive Quality Improvement: A Guide for Hospitals discusses and illustrates with specific examples how high-performance workforce and human resource practices can positively impact the quality of hospitals and health care institutions. IMPACT: The workforce practices guide has been downloaded more than 4,000 times. Identifying Best Practices to Improve Multi-Hospital Health System Performance Offers lessons transferrable to all hospitals. Supported by the Commonwealth Fund. This HRET guide illustrates the importance of developing a culture of performance excellence, having a clear set of defined values and expectations that form the basis for accountability results, and maintaining a disciplined and persistent focus by leadership on execution and implementation. It also provides numerous strategies and tools that leaders can use to help drive performance improvement, regardless if they are part of a health system. IMPACT: The multi-hospital system performance guide has been downloaded nearly 2,000 times.

9 Health Research & Educational Trust Health Care Leader Action Guide to Reduce Avoidable Readmissions Providing strategies to reduce avoidable readmissions, cut costs, and improve quality. Supported by the Commonwealth Fund and the John A. Hartford Foundation. As health care delivery in the United States moves toward a more integrated delivery model and greater accountability for care, many hospitals are working to reduce avoidable readmissions working not only within the hospital but also with other providers and care settings in their communities to improve coordination and transitions. This guide helps leaders assess, prioritize, implement, and monitor strategies to reduce avoidable readmissions during hospitalization as well as at discharge and post-discharge. IMPACT: The readmissions guide has been downloaded more than 6,500 times. AHA-NPSF Patient Safety Leadership Fellowship Mentoring leaders who work to improve quality and safety. The AHA-NPSF Patient Safety Leadership Fellowship is a year-long intensive learning experience that develops leadership competencies and promotes breakthroughs in safety practices through a dynamic, highly participatory and structured learning community. This nationally renowned fellowship provides health care professionals an opportunity to pilot evidence-based improvements and build a comprehensive approach to improving patient safety and developing a culture of safety in their organizations. Since its inception in 2001, the fellowship has attracted a multidisciplinary audience including physicians, nurses, administrators, quality and safety directors, risk managers, pharmacists and others. Action learning projects required of each fellow focus on designing reliable processes to improve teamwork, communications, data utilization, and care coordination throughout the patient care continuum. Co-sponsored by the National Patient Safety Foundation and produced in partnership with the American Organization of Nurse Executives, American Society for Healthcare Risk Management, Society of Hospital Medicine, and Health Forum. IMPACT: Since 2001, 262 health care professionals representing 178 organizations have participated in the PSLF. VISIT: www.ahafellowships.org

Making an Impact in 2010 10 AHA Health Care System Reform Fellowship Introducing a new fellowship focused on managing through health care reform. To be launched in 2011, the AHA Health Care System Reform Fellowship will provide participants with a road map on how to design and plan for new care delivery and payment models the medical home, accountable care organization, and bundled payments. During the six-month course, fellows will interact directly with their peers and fellowship faculty and learn from first-hand accounts about the challenges and key success factors to implementing these models. Designed for C-suite level executives and senior executives from finance, operations, strategy and physician relations/medical leadership, this fellowship combines in-person educational sessions and web seminars. Fellows also complete a six-month project designed to advance their organizations effort toward implementing one of the care delivery models. The inaugural group of health care system reform fellows will meet in February 2011. HRET has helped educate our medical staff and board on quality and safety issues and has translated the evidencebased research into understandable examples for use in strategic planning. ~ Mina H. Ubbing, President and CEO, Fairfield (Ohio) Medical Center "Drawing on the perspective of leading executives, researchers, and policymakers, HRET designs and conducts research and educational programs of unparalleled reach and impact in health services management, practice, and policy. ~ Douglas A. Conrad, PhD, Professor, Department of Health Services, University of Washington, Seattle

11 Health Research & Educational Trust During 2010, HRET published several implementation guides, synthesis reports, and toolkits that include actionable research. This information helps health care leaders design and implement quality and performance improvement strategies and address the challenges and opportunities of transforming health care delivery systems. Implementation Guides A Guide to Achieving High Performance in Multi-Hospital Health Systems Provides numerous strategies and tools that leaders can use to help drive performance improvement, regardless if they are part of a health system. IMPACT: Nearly 2,000 copies downloaded to date. Health Care Leader Action Guide on Implementation of Electronic Health Records Provides a road map to help senior executives develop a strategy to use EHRs that advances the organization s ability to deliver care that is safer, more effective, and efficient. IMPACT: More than 500 copies downloaded to date. Health Care Leader Action Guide to Reduce Avoidable Readmissions Helps hospital leaders assess, prioritize, implement, and monitor strategies to reduce avoidable readmissions during hospitalization as well as at discharge and post-discharge. IMPACT: More than 6,500 copies downloaded to date. Using Workforce Practices to Drive Quality Improvement: A Guide for Hospitals Includes practical advice on workforce practices that hospitals and health systems can adopt to develop a high-performing workforce that delivers safe, high-quality, and efficient health care. IMPACT: More than 4,500 copies downloaded to date.

Making an Impact in 2010 12 Research Synthesis Reports Accountable Care Organizations Bundled Payment Medical Home Each of these reports provides an overview of the concept, summarizes key conclusions learned from similar past projects, and offers key questions that should be considered by hospital and health system leaders when contemplating participating in upcoming federal demonstration programs. IMPACT: More than 4,000 copies of the ACO report, nearly 3,000 copies of the bundled payment report, and nearly 1,500 copies of the medical home report have been downloaded to date. Early Learnings from the Bundled Payment Acute Care Episode Demonstration Project Presents an overview and summary of lessons learned to date from the CMS Acute Care Episode Demonstration, a current CMS pilot project to test the effect of bundling Part A and B payments for episodes of care on the coordination, quality, and efficiency of care. IMPACT: Nearly 600 copies downloaded to date. HRET is a leader in the hospital field with its data, information, and assistance. HRET helps the hospital community to improve care through promoting transparency in sharing performance data, one of the Ten Simple Rules articulated by the Institute of Medicine. ~ David J. Ballard, MD, Senior Vice President and Chief Quality Officer, Baylor Health Care System, Dallas

13 Health Research & Educational Trust Toolkits HRET Disparities Toolkit: A Guide for Collecting Race, Ethnicity, and Primary Language Information from Patients Provides a comprehensive and systematic approach to collecting race, ethnicity, and primary language data and offers guidance on using this data to improve quality of care and reduce disparities for all populations. IMPACT: More than 18,000 visitors. VISIT: www.hretdisparities.org HIV Testing in Emergency Departments: A Practical Guide Helps clinicians and administrators navigate program design and resource allocation decisions for incorporating HIV testing in the ED, and also informs policies and operational approaches for such testing. IMPACT: More than 4,000 visitors. VISIT: www.edhivtestguide.org HIV Testing and Screening Cost and Reimbursement: A Package of Tools for Providers to Improve Quality of Care and Maximize Reimbursement Includes information on HIV testing and screening, including cost and reimbursement tools, to assist clinical managers and individual practitioners in starting or expanding an HIV screening or diagnostic testing program. IMPACT: Nearly 600 page views. VISIT: www.hret.org/quality/proj ects/hiv-testing-andscreening-cost-andreimbursement.shtml

Making an Impact in 2010 14 Health Services Research Published six times a year, plus two special issues, Health Services Research is HRET s flagship publication and an official journal of AcademyHealth. HSR publishes outstanding articles reporting the findings of original investigations that expand understanding of the wide-ranging field of health care and help improve the health of individuals and communities. In 2010, HSR published a theme issue on payment reform funded by AHRQ and a special issue, Health Services Research in 2020: Assessing the Field s Data Infrastructure Needs, supported by AcademyHealth, with funding from the Robert Wood Johnson Foundation and the Commonwealth Fund. Co-editors: José J. Escarce, MD, PhD, Ann Barry Flood, PhD IMPACT: Impact: HSR has more than 7,500 individual and institutional subscribers. Its impact factor is 2.407, a measure of the frequency that articles in a journal have been cited. In the 2009 Thomson Reuters Journal Citation Report, HSR is ranked 12 of 49 in health policy and services and 19 of 69 in health care sciences and services. VISIT: www.hsr.org TRUST Award Celebrating extraordinary health care leadership. Since 2003, HRET has presented the TRUST Award to individuals who have exhibited visionary leadership in the health care field and who symbolize HRET s mission of leveraging research and education to make a dramatic impact in policy and practice. Glenn D. Steele, Jr., MD, PhD, president and chief executive officer of Geisinger Health System, Danville, Pa., is the 2010 TRUST Award recipient. View photos from the 2010 TRUST Award reception. Past TRUST Award recipients Donald M. Berwick, MD, MPP Janet M. Corrigan, PhD David M. Lawrence, MD, MPH Robert H. Brook, MD, ScD, FACP Brent C. James, MD, MStat David Satcher, MD, PhD Gail Warden, MHA For More Information Visit our website at www.hret.org for more information on all HRET research projects and educational activities.

15 Health Research & Educational Trust 2010 HRET Board of Trustees Alfred G. (Al) Stubblefield (Chair) President Baptist Health Care Michael Chernew, PhD Professor Department of Health Care Policy Harvard Medical School Douglas A. Conrad, PhD Professor Department of Health Services University of Washington Jim Conway Senior Fellow Institute for Healthcare Improvement Brenita Crawford Assistant Professor Division of Health Administration School of Urban Affairs and Public Policy University of Memphis Crystal L. Haynes Chief Executive Officer Saint Louis University Hospital John G. O'Brien President and CEO UMass Memorial Health Care, Inc. Joan Y. Reede, MD, MPH, MBA Dean for Diversity and Community Partnership Harvard Medical School John R. Rivers Former President and CEO Arizona Hospital and Healthcare Association Jeff Selberg Executive Vice President and Chief Operating Officer Institute for Healthcare Improvement Richard J. Umbdenstock President and CEO American Hospital Association Lorrie Warner Managing Director Citigroup Global Markets, Inc. Charlotte Yeh, MD, FACEP Chief Medical Officer AARP Services, Inc. Thomas F. (Tom) Zenty, III Chief Executive Officer University Hospitals Health Research & Educational Trust 155 North Wacker Suite 400 Chicago, IL 60606 312-422-2600 www.hret.org